The invention relates to systems which assist in moving, transporting, repositioning, and rolling over patients who are partly or completely incapacitated. The invention more particularly relates to systems which give a single health care worker the capability to move a patient from one bed to another bed, between a bed and a cart or gurney, between a sitting and a standing position, or from a slumped position in a chair or bed to a more elevated position.
Health care workers at hospitals, nursing homes, and home care programs face the challenge of moving partly or completely incapacitated patients. A typical patient weighs between 45 and 90 kilograms, although many others weigh more. Consequently, at least two to four health care workers are usually needed to move the patient. These activities often create unacceptable risks of injury, almost without regard to the number of health care workers used in the patient transfer. The risks are particularly high when a sufficient number of workers is not available to assist in a patient transfer. For example, injuries to workers"" backs account for approximately 50% of worker""s compensation costs for work place injuries in the health care industry in the United States. Thus, back injuries to health care workers are a particularly vexing problem.
Patient transfers can be placed in several broad categories. A first category includes the horizontal transfer of a patient from one flat surface to another. A second category involves upright transfers where a patient is moved from a horizontal position to an upright or sitting position in a wheelchair, chair or commode, and the return of the patient to the horizontal position from an upright or sitting position. A third category of transfer relates to the positioning or movement of patients in order to change their position in a bed or chair, for example pulling the patient up in the bed or rolling the patient from side to side. Although many attempts have been made to devise improved systems for patient transfer, almost all of these transfers continue to be manually performed.
Current healthcare guidelines typically recommend that four health care workers participate in a patient transfer. Two workers are at the bed side and two workers are at the cart side. Each worker grabs an edge of a draw sheet, which is positioned under the patient. The patient is then transferred between the bed and the cart through a combination of lifting, pulling, and pushing. An elongated plastic sheet is often placed beneath the patient to reduce friction or drag. Since a health care worker has to bend over at the waist to accomplish these patient transfers, the stresses encountered are magnified well beyond what would otherwise be expected for a maximum recommended lift of approximately fifty pounds. Normally this recommended maximum lift is measured with the lift at or near the worker""s center of mass. Extremes in a health care worker""s height, either taller or shorter than average, or any weakness in either the arms or legs further exaggerate these risks.
Many hospitals have swing-type mechanical lift devices to assist in certain patient transfers. However, these devices are not widely used because they are often cumbersome and time-consuming to set up and operate. Depending on the lift required, the devices may also be inappropriate.
The upright transfer and positioning categories provide similar difficulties, especially if the patient is unable to cooperate. For example, weak and elderly patients reclining in a semi-erect position tend to slide down. These patients must be returned to a position more toward the head of the bed. To do so, two health care workers usually grasp the patient by the upper arms to hoist the patient toward the head of the bed after the bed has been lowered to a more horizontal position. This manual transfer often causes strain on the workers"" upper and lower backs and possible contact bruises on the patient. Similar difficulties occur with upright transfers.
Given these formidable difficulties, there have been other attempts to mechanize the patient transfer process. For example, U.S. Pat. No. 2,665,432 (Butler), describes a cart with a manual crank connected to an extensive pull unit. The pull unit has a large number of straps which connect at an edge by hooks to a transfer sheet. Rotation of the crank winds the pull unit onto a roller. The size of the pull unit presents many difficulties including it attachment at many locations to the sheet and the awkwardness of winding it on the roller. The pull unit must be placed under the patient just prior to transfer, since it would not normally be kept there. Also, no means are provided for transferring the patient off the cart.
U.S. Pat. No. 2,827,642 (Huff) describes a similar system mounted to the head of a bed and designed to move a patient from the foot toward the head of the bed. The ""642 Patent does not describe the process of moving a patient laterally from one horizontal surface to another.
U.S. Pat. No. 4,970,738 (Cole) discloses another patient transfer system which employs a manual crank and self-locking gear system. This system has an advantage over the system described in the ""432 patent in that the transfer is reversible. Rotating the crank drives a belt system, which is attached to a semi-rigid transfer apron. The apron is thereby transferred horizontally while supporting a patient. This system has the disadvantage that the apron must be first positioned under the patient before the patient can be transported from a bed onto a cart. Another disadvantage is that the transfer support alone does not provide sufficient support for the patient or the transfer system. Because of the complexity of its design, considerable operator interaction would be required for the transfer support to be mounted to a cart and then operated to transfer a patient.
U.S. Pat. No. 2,733,452 (Tanney) describes a transfer system that uses a motorized pulley to transfer a patient on a metal-reinforced transfer sheet. The transfer sheet has metal grommets in its corners for attachment to cables. A motor is used to wind the cables onto reels thereby resulting in the transfer of the sheet and the patient thereon. However, the patient must first be moved onto the transfer sheet before being moved from a bed to the cart. Moreover, this invention fails to provide support beneath a patient being transferred.
U.S. Pat. Nos. 4,747,170 and 4,868,938 (both to Knouse) reveal a motorized winch-type transfer system. This transfer system has apparent advantages over the transfer system of the ""452 patent, which include a more secure transfer sheet gripping mechanism and the use of a transfer sheet which does not need grommets or other similar devices. Though more secure, the gripping system is difficult and awkward to use.
U.S. Pat. No. 5,038,424 (Carter et al.) teaches a system for reciprocally transferring a patient between a bed and a cart. This system employs a pliable transfer web wound about two detachable, cylindrical rollers and a drive motor mounted on the bed and the cart. In use, the bed and cart are positioned side-by-side and the web is placed beneath the patient. The roller adjacent the cart or bed onto which the patient is to be transferred is detached. While unwinding a sufficient length of transfer web wound thereon, the roller is extended to the opposite side of the bed or cart onto which the patient is to be transferred, and there connected to the drive motor. The drive motor is then activated, thereby rewinding the transfer web onto the roller and transporting the patient disposed thereon. Thus, while enabling reciprocal transfer, the system of the ""424 patent is time consuming and awkward to set up. Moreover, as in the previous inventions discussed hereinabove, the patient is not supported adequately while being transferred.
While considerable effort has gone into developing horizontal patient transfer systems, all of the systems previously developed have significant drawbacks. These drawbacks primarily relate to the significant difficulties encountered in set-up and operation.
The patents described hereinabove primarily relate to systems for transferring patients from one horizontal surface to another horizontal surface. By partial contrast, U.S. Pat. Nos. 4,700,415 and 4,837,873 (both to DiMatteo et al.) teach a system for transferring patients between a reclined wheelchair and a bed. The bed is equipped with a sheet wound about a right side roller and a left side roller. The sheet is positioned beneath a patient reclining thereupon. The right and left side rollers are positioned laterally on each side of the bed, usually slightly below the plane of the patient. Two corner rollers are situated above the right side and left side rollers. The two corner rollers are approximately level with the top surface of the bed. The reclined wheelchair is equipped with two articulated rollers. Extending between these articulated rollers is a sheet, the sheet including three bands. The lateral edges of the sheet may be joined or separate. If the lateral edges are to be joined, the sheet spans above and below the wheelchair upper surface. If the lateral edges are free, the sheet spans the wheelchair upper surface with its ends wound about the two rollers. The separate transfer systems for the bed and wheelchair must be powered such that both sheets rotate with equal velocities. In use, the patient reclining upon the bed is conveyed laterally by the bed transfer system. Upon encountering the wheelchair transfer system, the patient is thereupon further conveyed onto the wheelchair. The wheelchair may then be further adjusted, allowing the patient to assume a sitting position.
The system of DiMatteo allows for transfer to or from a reclining wheelchair and for adjusting the wheelchair between sitting and reclining positions. However, its shortfalls include the complexity of its design, the need to retrofit beds with the rollers and sheet provided, and the possibility of pinching the patient or catching clothing in the gaps between the bands.
U.S. Pat. No. 3,597,774 (Warren) describes a harness and winch mechanism for raising a patient reclining upon a bed. The winch is mounted to a post attached to the head of the bed and is operated by a hand crank. The harness loops under the patient""s armpits such that excessive stress may be applied thereto during operation of the device.
The invention includes devices for transferring patients which greatly simplify, and provide enhanced versatility over, any known device. The adoption of these transfer devices will likely reduce the wide incidence of back injuries in health care workers. A first system for the horizontal transfer of patients is adapted to use existing transfer sheets and an appropriately modified cart. The sheet is readily attached to a clamping device close to the patient. The clamping device has a releasable catch which holds the sheet. One or more straps are attached to the clamping device, and the other ends of the straps are attached to reels that are part of a winch. Activation of the winch winds the straps onto the reels. In a highly portable embodiment of this transfer device, the entire apparatus may weight only about 8-15 kilograms, and may be readily attachable and removable to bed and cart rails.
A long narrow rectangular cushion can be placed between the bed and cart when using the portable transfer device. The cushion is, optionally, the length of the bed, and may be partially coated with a low friction surface. The cushion may have fasteners for attachment to a bed or cart, or it may also be configured to hang from the side of the bed or cart by the fasteners when not in use. The cushion is particularly convenient when used with a portable transfer device of the invention because no other modifications to the bed or cart may be needed.
Other embodiments of horizontal transfer devices facilitate the transfer of the patient by providing some lift to the patient as well as horizontal motion. The vertical and horizontal transfer mechanisms may both be operably attached to a single bed or cart frame. One embodiment of a horizontal transfer mechanism within the invention has a transfer element that moves within tracks. Another embodiment of a horizontal transfer system of the invention moves the patient on a modularized cushion. In other embodiments, lift is added by use of a harness which provides significant advantage in distributing the weight of the patient without the need to lift the patient to place a portion of the harness under the patient. The harness has a support that goes across the patient""s upper body. Another portion of the harness goes under the patient""s arms. The harness has a fastener that attaches a lift mechanism near the back of the patient""s head.
An improved patient transfer system is capable of transferring a patient using only a single attendant. The transfer system includes patient transfer means for transferring the patient, a transfer sheet, a retaining member assembly operably coupled to the patient transfer means and a contact element assembly.
The improved transfer system may also include a highly portable transfer unit. The portable transfer unit may be totally self-contained or may be installable on a bed or cart and connectable to a separate clamp. The portable transfer unit may utilize a plurality of detachable spools, as well as means for sensing the proximity of a patient being transferred and means for discontinuing the transfer in response to the sensing.
The improved transfer system may still further include a transfer bridge support means for supporting a patient being transported when the patient spans the bed or cart. The transfer bridge support means may be foldable and may include a stabilizer, a cross sectional camber and a leading edge camber to further prevent the transfer bridge support means from being displaced during patient transfer, and improved slip-resistant features.
A system for enabling a person to singly and ergonomically transfer a patient disposed on a sheet as provided. The system may include a caddy. The caddy may include means for enabling the person to transport the caddy from a first location to a second location, a power train, a hook and web assembly attachable to the power train, a power and switching system in electrical communication with the power train, and means for adjusting a vertical position of the hook and web assembly. The transport means may be operably disposed proximate the caddy. The system may further include means for gradually accelerating and decelerating a transfer force exerted by the power train. The power train may include a motor and a plurality of spools in mechanical communication with the motor. The plurality of spools may further be in mechanical and magnetic communication with the motor. The power train may still further include a plurality of magnetic clutch assemblies and a plurality of slip plates. Each magnetic clutch assembly may be in mechanical communication with the motor and each slip plate may be in magnetic communication with one of the magnetic clutch assemblies. Each spool may be in mechanical communication with one of the slip plates.
The hook and web assembly may include a plurality of webs and a plurality of transfer hooks, each web being connectable to one of the spools and each transfer hook being connectable to one of the webs. The power and switching system may further include means for automatically discontinuing a transfer. The system may provide a transfer rod, the transfer rod accommodating the transfer hook when at least a portion of the transfer sheet is wrapped around the transfer hook. The transfer rod may include a plurality of joinable sections, the sections may be elastically connected.
The system may further include a transfer bridge. The transfer bridge may further include a low-friction surface and a plurality of sections, foldable into a generally facing relationship.
There is also provided a movable caddy for enabling a single person to ergonomically turn a patient disposed on a sheet in cooperation with sheet-gripping means or to transfer the patient from a first horizontal surface to a second horizontal surface in cooperation with the sheet-gripping means. The caddy may include a base assembly, the base assembly including means enabling a single person to transport the caddy from a first site to a second site, a vertical adjustable head assembly, the vertical adjustable head assembly including a power train, the power train including a motor, a plurality of magnetic clutches, a plurality of slip plates, and a plurality of spools. Each magnetic clutch may be in mechanical communication with the motor. Each slip plate may be in magnetic communication with one of the magnetic clutches. Each spool may be in mechanical communication with one of the slip plates. The magnetic clutches and the slip plates may cooperate to exert a gradually accelerable transfer force. The system may further include a hook and web assembly with a plurality of webs and means for gripping the sheet. A first end of each web may be windably attachable to one of the spools. The sheet-gripping means may be attachable to a second end of each of the belts. The sheet-gripping means may grip a portion of the sheet, thereby transmitting the transfer force to the gripped sheet. The sheet-gripping means may include a plurality of transfer hooks and a transfer rod. Each transfer hook may be attachable to a second end of each belt and each transfer hook may cooperate with a transfer rod to grip the sheet.
There is also provided a transfer rod for cooperatively gripping and exerting a transfer force on a sheet. A portion of the sheet may be partially enwrapped around the transfer rod, the transfer rod exerting the transfer force in cooperation with the plurality of transfer hooks. The transfer rod may include means for mating with the transfer hooks.
There is also provided a transfer bridge. The transfer bridge may include a first inboard member, a plurality of outboard members, means for interfolding the inboard and outboard members, and means for reducing friction arising from contact between a sheet and the transfer bridge. An outboard member may extend from a lateral edge of the first inboard member. The transfer bridge may include a second inboard member and an outboard member may extend from each inboard member.
There is provided a substantially pliable underlayment for transferring, repositioning, or rolling a patient disposed thereon, the underlayment including a substantially smooth mantle proportioned to accommodate at least a central portion of the patient""s body, an attaching structure operably adjacent the mantle, and a reinforcing structure for imparting a resistance to distortion of the mantle in response to a force exerted on the attaching structure.
There is also provided a method of transferring or repositioning a patient disposed on a substantially pliable underlayment, the method comprising the steps of providing the substantially pliable underlayment, the underlayment including a substantially smooth and pliable mantle, an attaching structure operably adjacent the mantle, and a reinforcing structure for imparting a resistance to distortion of the mantle in response to a force exerted on the attaching structure; attaching a connecting member to the attaching structure; and exerting the force on the connecting member, the force being sufficient to displace the patient.